Joint Office homeless shelters: The Joint Office responded quickly by adding shelter sites to allow for physical distancing, but faces challenges going forward
The Multnomah County Joint Office of Homeless Services (Joint Office) oversees county and City of Portland homeless services. Multnomah County and Portland share governance, policy implementation, and funding for the Joint Office to address houselessness.
The Joint Office contracts with local nonprofit agencies to provide shelter services for adults, families, domestic and sexual violence survivors, and homeless youth. Prior to the pandemic, the Joint Office provided approximately 1,400 shelter beds plus additional temporary shelter during severe weather events. The adult shelters typically have dormitory style sleeping areas, often with bunk beds in a confined space. The family shelters provide private rooms for sleeping and shared common areas. As in past years, shelter programs operate at very high to full capacity, especially in winter.
Many people experiencing homelessness are older, and many have underlying health conditions, placing them at higher risk for severe consequences from COVID-19.
Early in the pandemic, the Joint Office partnered with the county’s Emergency Operations Center and County Emergency Management’s Mass Sheltering/Disaster Recovery Center team to form a shelter response. To minimize the risk of infection among shelter participants, they undertook a massive effort to open additional shelter sites. The expanded operations allowed for more physical distancing, but did not increase overall shelter capacity.
Homeless shelters, like other congregate living facilities, are vulnerable to COVID-19 spread because so many people are in one location. Additionally, unlike some other congregate facilities such as jails, guests are free to come and go from the shelter. Guest and staff contacts outside the shelter, as well as turnover in the shelter population, add to COVID-19 exposure risk. This increased risk makes following guidance on face coverings and physical distancing even more important.
As part of our audit, we conducted an employee survey to better understand employee experiences during the pandemic and tools and support employees need to be better able to work during the pandemic. While many county employees worked at county-operated shelters during the pandemic, the majority of shelter workers work for nonprofit agencies and did not receive our survey. We received too few responses from county-assigned shelter workers to report on quantitative shelter responses, due to our policy of not presenting data from groups with fewer than 30 respondents. However, we will report on themes from comments from county-assigned shelter workers.
Does the county have a written plan for how to respond to the pandemic and future outbreaks?
The shelter system provides COVID-19 guidance to providers on its public-facing website. Joint Office and county Public Health staff also share information with providers during a weekly meeting and through emails. County policies about COVID-19 operations apply to county-run shelters.
Under guidance from the county Office of Emergency Management, the Joint Office was in the process of developing a continuity of operations plan when the pandemic started. Staff from the Joint Office said they were well positioned and practiced for an emergency. They already operate under emergency conditions, like when there is severe weather.
According to Public Health officials, Public Health follows guidance from the Oregon Health Authority and Centers for Disease Control and Prevention (CDC) in investigating outbreaks at shelters. The county also included an explanation of the procedures it would follow if there were an outbreak at a homeless shelter in its application to the state for reopening.
Where does the county’s shelter guidance come from?
The Multnomah County Health Department is responsible for guidance to shelter providers and consulted with Central Human Resources on county policies. The Health Department gets its guidance from the CDC and the Oregon Health Authority, but also has some discretion as the Local Public Health Authority.
Physical distancing adaptations
What changes have they made to physical layouts and operations for providing services and continuing operations?
The Joint Office, in partnership with Public Health and Multnomah County’s Emergency Operations Center, made several changes in the shelter system in response to COVID-19. The initial effort was to add shelter sites in order to increase the amount of space for each participant, and reduce virus spread. The county added four temporary locations with a total of 375 additional beds. The new locations allowed existing shelters to reduce their capacity and increase space per person by moving many participants to the new sites. These new locations increased the total physical space for shelters, but did not increase the number of participants in the shelter system.
The new locations were in government-owned buildings that were not being used as their services had been closed down due to COVID-19 related closures. The new sites were:
- The Oregon Convention Center
- The Charles Jordan Community Center
- East Portland Community Center
- Mt Scott Community Center
Other changes in operations occurred over the next several months, including:
- The City of Portland opened three outdoor emergency shelters supplied with tents, cots, and sleeping bags.
- The county opened voluntary isolation motels to provide a safe place to isolate those with COVID-19 symptoms, those who had been exposed to COVID-19, and those who tested positive for COVID-19. These motel rooms were used by people who had been staying in the shelter system as well as community members.
- The Joint Office opened six physical distancing motel shelters to house the most vulnerable shelter participants, based on factors including age, medical conditions, and race/ethnicity.
- The motels replaced the shelter capacity at other locations and as motel sites opened, the county began to close down most community center sites.
- The shelter system opened additional sites beginning in October 2020 and transitioned the former Greyhound station in Portland’s Old Town into a temporary shelter.
Initially the county Emergency Operations Center opened the new shelters, then shifted most management to nonprofit agencies. At the time of our audit, the Emergency Operations Center and the Joint Office continued to manage the voluntary isolation motels and one community center location. The Joint Office included culturally responsive agencies as shelter providers and, according to management, the system made an effort to bring in staff with racial equity experience and an understanding of serving Black, Indigenous, and People of Color (BIPOC) communities.
The traditional shelters managed by providers made a few modifications to the physical layouts in response to the pandemic. As the county added new shelters to spread people out and allow for social distancing, the number of participants in nonprofit shelters was about half compared to before the pandemic.
Shelters providers made changes to layout and operations to prevent COVID-19 spread. Shelters added signage and hand sanitizing stations, increased cleaning protocols, and spaced out where people slept. We confirmed this with onsite visits to some shelter locations as well as through interviews with providers and Joint Office managers.
Shelter providers employed various strategies to adapt, such as spaced out sleeping and seating areas, and had staff serve meals rather than allowing participants to serve themselves. In other cases, staff distributed meals to participants.
The Joint Office has tried to minimize the risk of COVID-19 exposure by encouraging participants to stay in facilities and avoid going out into the community. Shelters provide three meals a day and space for physical distancing. One provider told us they have spaces for activities, with computers, a TV, a library, and space for art work.
What oversight and support was the Joint Office providing at the time of the audit to contractors for changes to physical layouts and operational adjustments for more physical distance?
Early in the pandemic, the county put out guidance for congregate shelters. The Joint Office checked in with shelter providers and Public Health, and began hosting call-in meetings with nonprofit agencies and other interested community members. In these meetings participants shared information and planning for a COVID-19 response among those who serve community members experiencing homelessness. During the calls, they discussed emerging best practices, shared information from Public Health, and discussed common concerns. They initially held meetings at least twice each week, then held weekly meetings, and moved to biweekly meetings at the time of our audit. After the meetings the Joint Office issued an email with links to guidance and resources related to the call. Providers and county staff told us that 100 or more providers and community members attended the early meetings.
Upon the request of providers, Public Health officials conducted site visits to advise on practices for COVID-19 safety. For example, one provider told us that a deputy Public Health officer visited their location to help advise on safety concerns. The Joint Office increased funding to provider contracts to purchase needed supplies, such as masks and sanitizing products.
What guidance or protocols were there for visitors?
According to the Joint Office, shelter providers have ‘no visitor’ policies with the exception of limited visits by case managers and other social service or specialty providers. Visitors, along with staff and residents, were required to wear masks.
Is there a policy about face coverings?
Requiring face coverings in shelters is a critical part of the county’s strategy to reduce COVID-19 risks. Guidance for face coverings has changed throughout the pandemic.
At the time of this report, there were two sets of guidance for face coverings:
- The internal county policy only applied to the shelters that the county runs. At the time this report was written, there was only one county-run congregate shelter. There are also two county-run voluntary isolation motels. Isolation motels provide rooms and services for people to isolate safely while they are infectious with COVID-19 or waiting for test results. The rooms are for people in the houseless community and others who cannot safely isolate at home.
- Public Health also provides external guidance, on the county’s public facing website, to nonprofit shelter providers within county boundaries. Many nonprofit shelter providers have contracts with the county. Some of the contracts include a requirement to follow this guidance.
The internal county policy requires that staff wear a face covering unless they are at a private workstation. According to the internal county policy, shelter guests are also required to wear a face covering, except when eating or drinking. The isolation motels do not have their own specific guidance, but guests are in private rooms and would not be expected to wear masks in those rooms.
The county’s external guidance is not clear. In addition to linking to the state’s face covering guidance, it also has a section recommending face coverings for staff and clients “to the extent possible.” This is short of the state requirements and the county’s internal policy. A Public Health official told us that they recall this section allows for different types of shelters that are set up in different ways (for example families in rooms, with shared kitchens, bathrooms, and common areas). However, this intention is not clear and it is still contrary to the most recent state requirements.
Were face coverings being worn?
Overall, it appeared that the shelters were following guidance and were working to ensure that staff and guests wear face coverings.
During the audit, we visited a few shelter facilities, both county and contractor run. We observed staff and guests wearing face coverings. The only exceptions were guests not wearing face coverings at tables six feet apart in a dining area and while smoking outside. We also saw some people wearing face coverings incorrectly, not covering their noses or with face coverings on their chins. Since we only visited a few locations, we cannot say with certainty that this was the case at all locations, all the time.
According to interviews, Joint Office staff and providers have become more assertive with enforcing the wearing of face coverings as state guidance changed. However, it is not simple. For homeless shelters, there is an additional concern that excluding someone for not wearing a face covering could put them in a dangerous situation without shelter. We were told that staff have to frequently remind guests to wear face coverings correctly.
Several respondents to our employee survey reported concerns about guests at shelters not wearing face coverings consistently. However, it is possible that respondents were referring to earlier times when guidance was different.
Did the shelter system have sufficient supply of face coverings at the time of the audit? Do they have sufficient supply going forward?
The shelters primarily use cloth face coverings and report having sufficient supplies. Typically, guests are responsible for washing their own masks and laundry facilities or services are available. Early in the pandemic, when some items were in short supply, the county distributed supplies to nonprofit providers. Now providers can purchase their own pandemic-related supplies. The county added funds to their contracts for this purpose. The Joint Office also maintains a supply site for providers. The Emergency Operations Center manages supplies that can serve as backup for the community, including shelters if needed. As of November 2020, the Emergency Operations Center had hundreds of thousands of cloth face coverings on hand.
Personal Protective Equipment (N95 masks, face shields, gloves, etc.)
Did they have sufficient supply? Do they have sufficient supply going forward?
County Public Health does not require routine use of respirator masks (N95 or KN95) at shelters for COVID-19 protection. Some PPE is available at shelters. According to Joint Office staff, procedural masks, respirators (KN95s), and gloves are available. “Spill kits” are available for cleaning biohazards. According to Joint Office staff, PPE is also available at the voluntary isolation motels in the unlikely event that a staff member has to enter a room. However, under most circumstances staff interact with guests at their doorway, 6ft apart, using face coverings.
The Joint Office did not report supply issues. The Emergency Operations Center can serve as a backup for supplies for the community, which can include shelters. As of November 2020, the Emergency Operations Center had hundreds of thousands each of KN95s and procedural masks on hand.
When preparing to open new shelter locations early in the pandemic, the Joint Office and Emergency Operations Center needed numerous people to help set up and staff the new sites. County leadership issued a request asking employees to voluntarily be assigned to work at the new emergency shelters.
They also appealed to the community for help and hired a large number of temporary employees to work in various shelter and motel settings.
Some county employees volunteered to set up and work at the new shelters. Some county staff expressed concerns about working in shelters or motels. The Emergency Operations Center also hired temporary staff to help operate the new shelters.
Are there enough staff moving forward?
According to the Joint Office and shelter providers, staffing is currently adequate but future staffing is a concern. The risk of virus transmission can make the positions difficult to fill. The Joint Office provided nonprofit shelter staff with a $2 per hour increase as an incentive to retain them.
Some are worried about the possibility of future staffing shortages. One provider said that staffing is always a challenge. Adequate staffing going forward is the primary concern.
How had the shelter system adjusted intakes and did the approach appear safe?
Early in the pandemic, shelter providers limited new intakes to keep the number of people down. Now, the intake process is similar to before the pandemic. As in the past, participants can be referred through the 211 information and referral system, another provider, outreach workers, or by signing up on the provider wait list. When a shelter space is available, the applicant is notified and intake screening begins.
Shelter providers screen new participants for COVID-19 symptoms. They also conduct a public health risk assessment which includes an evaluation of COVID-19 risks, such as age and medical conditions. If no COVID-19 symptoms are present, participants are accepted into the facility.
The Joint Office told us that everyone is screened daily for COVID-19 symptoms, including temperature checks. If a person’s temperature is over 100 degrees, the provider makes a referral to the isolation motel. In the isolation motels, two symptom checks are conducted each day.
Does the current approach mean some people are not being served?
Similar to conditions prior to the pandemic, there is not enough shelter space to serve all who seek shelter. Many shelters have reservation or referral systems with priority for aging and vulnerable people. There is currently a waiting list for many shelters.
Portland and the county increased capacity for winter shelters starting in October 2020, adding 275 new winter shelter beds. According to management, this brings the total to nearly 1,700 shelter beds in the system. Participants are provided with 24/7 access to the shelter and three meals a day. This is a higher level of service than the Joint Office offered in winter shelters in past years, when fewer meals were served and shelters were open only at night and not available during the day.
In the past, the county has had a no-turn-away policy during severe weather. When severe weather is declared, the Joint Office said they would stand up more beds and keep those beds open for the duration of a particular severe weather event.
What is the Joint Office doing with clients or staff who exhibit symptoms or test positive?
Providers told us that keeping staff and guests safe and healthy is a very high priority. Staff are not allowed to work in shelters when they have symptoms, have been exposed to someone who tested positive for COVID-19, or have tested positive themselves.
Transportation providers take symptomatic participants, or those who have tested positive, to voluntary isolation motels or hospitals. After a quarantine period, participants may return to the shelter.
What processes did they have in place to monitor contracted shelter providers?
The Joint Office hosts regular call-in meetings with providers, and Joint Office staff visit sites periodically to address concerns as they arise. Joint Office staff worked with providers to set up or transition new locations to providers, which gave them the opportunity to observe provider practices. Joint Office staff said they follow up on reported concerns and are well aware of trouble spots.
Joint Office staff and contracted providers told us that shelters are at great risk if they don’t follow COVID-19 protective practices, such as wearing masks, practicing physical distancing, and sanitizing. Staff may not want to work if they perceive increased risks and the facility might have to close if they have an outbreak at their shelter.
Did the Joint Office have sufficient contract authority to require contractors to operate homeless services in alignment with Multnomah County Public Health guidance?
Joint Office management reported no issues with contract authority in terms of COVID-19 policies. Some Joint Office shelter amendments issued for FY21 require providers to operate homeless services in alignment with current Multnomah County Public Health COVID-19 Guidance and provide a link to the guidance in the contract.
What are the biggest concerns going forward?
This winter could be challenging for shelters during the pandemic. With the weather getting colder, more people will want to be inside. It will be hard to differentiate cold and flu symptoms from COVID-19 symptoms. An increase in COVID-19 cases in the community will add risk.
A large outbreak at a shelter:
As of mid-December 2020, there have not been any reported large outbreaks at any county-run or contracted homeless shelters. The preventive work by the Joint Office may have helped lessen outbreak risks. However, if an outbreak were to occur, it could pose challenges with staffing and having adequate space for isolation.
Consistent funding and capacity challenges:
Temporary CARES Act funding has paid for much of the increase in homeless services. Moving forward, funding will be a concern, staffing will be difficult, and the need for supplies will continue. Additionally, there could be a substantial increase in homelessness because of economic conditions. Provider capacity is already strained. An increase in homelessness may place demands on shelter providers that they will not be able to satisfy.
- Upon issuance of this report, county Public Health officials should revise guidance on the public facing website for nonprofit shelter providers within county boundaries to improve clarity, in line with state requirements.
- Joint Office of Homeless Services management should include clauses to follow Public Health guidelines in new contracts with shelter providers and in new amendments to contracts with shelter providers.